General Surgery Rosh Review UPDATED ACTUAL Questions and
CORRECT Answers
1. Pyloric Stenosis Rapid Pyloric stenosis is defined as pyloric hypertrophy causing gastric outlet
review obstruction.
- 2-8 weeks of age, boys > girls
- Nonbilious projectile vomiting after feeding, early satiety
- Clinical: dehydration, RUQ olive-like mass
- Labs: hypochloremic hypokalemic metabolic alkalosis
- Dx: The classic findings on ultrasound will show a target sign on the
transverse view and a thickened and elongated pyloric muscle.
- Tx: surgery
2. Pancreatic carcinoma - Risk factors: history of smoking
rapid review - Sx: abdominal or epigastric pain, painless jaundice, weight loss,
anorexia
- Labs: CA 19-9 serum marker useful in monitoring
- Dx: U/S, ERCP or MRCP, CT, endoscopic ultrasound
Management:
- Resectable disease: Whipple procedure (pancreaticodudenectomy) +
adjuvant chemo
- Unresectable disease: FOLFIRINOX or gemcitabine-based chemo
- Most common type is adenocarcinoma
- Poor prognosis..
3. What are the grades Grade I consists of mild confusion and sleep disturbances without
of hepatic encephalopa- asterixis.
,thy?
, Grade II consists of moderate confusion and lethargy with asterixis.
Grade III consists of severe confusion, incoherent speech, and asterixis.
Grade IV is marked by patients being comatose and unresponsive.
4. What are precipitating Precipitating causes include gastrointestinal bleeding, infection, con-
causes of hepatic en- stipation, medication noncompliance, kidney injury, or metabolic de-
cephalopathy? rangements.
5. Treatment for hepatic Patients with grade I and sometimes grade II hepatic encephalopathy
encephalopathy based may be discharged if there is a proper caregiver at home.
on grade?
Patients with grade III or IV must be admitted to the hospital and often
to the intensive care unit.
Lactulose is a synthetic disaccharide used to treat hepatic encephalopa-
thy.Rifaximin is a nonabsorbable antibiotic that can be administered
in addition to lactulose for patients who do not improve with lactulose
alone.
6. What are internal hem- Internal hemorrhoids are a normal anatomical part of the anal canal.
orrhoids made of? These hemorrhoids consist of connective tissue, smooth muscle fibers,
and terminal branches of the rectal arteries and veins providing normal
closure and pressures in the anal canal.
7. What do internal hem- They are located in the right anterior, right posterior, and left lateral
orrhoids arise from? areas of the canal and arise from the superior hemorrhoidal cushion.
8. What are external hem- External hemorrhoids are veins located below the dentate lineand are
orrhoids made of? superficial vessels covered with squamous epithelium.
9. Difference between vol- Image
untary and involuntary
, guarding on abdominal
exam?
10. Zollinger Ellison syn- - Gastrin-secreting tumor, causes peptic ulcer disease
drome rapid review - Found in duodenum, pancreas, often malignant
= Sx: abdominal pain, chronic diarrhea, weight loss
- PE: epigastric tenderness
- Endoscopy will demonstrate prominent gastric folds and solitary pep-
tic ulcers typically located in the duodenum.
- Labs: elevated serum gastrin level (> 1,000 pg/mL)
- Tx: H2 blockers, PPI, surgery
- Associated with MEN1
If results of the gastric acid pH and serum fasting gastrin levels are
equivocal or nondiagnostic, then a secretin stimulation test is used to
differentiate Zollinger-Ellison syndrome from other causes of chronically
elevated gastrin levels.
11. What does secretin do? Secretin stimulates gastrinomas to release gastrin, therefore, patients
with Zollinger-Ellison syndrome will have a marked rise in serum gastrin
levels after the administration of secretin
12. What is a gastric bypass During this procedure, a small gastric pouch is created that is connected
procedure? to a loop of jejunum. The rest of the gastric remnant is left in place and
the proximal duodenum is connected to the distal jejunum. This creates
a bypass of a large portion of the stomach, duodenum, and proximal
jejunum. The procedure reduces the size of the stomach while creating
a short biliopancreatic tract.
13. In a gastric bypass pro- gastric volume, calories
cedure :
The surgery also creates changes in gut hormones, such as incretin, that
The procedure works by are thought to contribute to overall weight loss.
CORRECT Answers
1. Pyloric Stenosis Rapid Pyloric stenosis is defined as pyloric hypertrophy causing gastric outlet
review obstruction.
- 2-8 weeks of age, boys > girls
- Nonbilious projectile vomiting after feeding, early satiety
- Clinical: dehydration, RUQ olive-like mass
- Labs: hypochloremic hypokalemic metabolic alkalosis
- Dx: The classic findings on ultrasound will show a target sign on the
transverse view and a thickened and elongated pyloric muscle.
- Tx: surgery
2. Pancreatic carcinoma - Risk factors: history of smoking
rapid review - Sx: abdominal or epigastric pain, painless jaundice, weight loss,
anorexia
- Labs: CA 19-9 serum marker useful in monitoring
- Dx: U/S, ERCP or MRCP, CT, endoscopic ultrasound
Management:
- Resectable disease: Whipple procedure (pancreaticodudenectomy) +
adjuvant chemo
- Unresectable disease: FOLFIRINOX or gemcitabine-based chemo
- Most common type is adenocarcinoma
- Poor prognosis..
3. What are the grades Grade I consists of mild confusion and sleep disturbances without
of hepatic encephalopa- asterixis.
,thy?
, Grade II consists of moderate confusion and lethargy with asterixis.
Grade III consists of severe confusion, incoherent speech, and asterixis.
Grade IV is marked by patients being comatose and unresponsive.
4. What are precipitating Precipitating causes include gastrointestinal bleeding, infection, con-
causes of hepatic en- stipation, medication noncompliance, kidney injury, or metabolic de-
cephalopathy? rangements.
5. Treatment for hepatic Patients with grade I and sometimes grade II hepatic encephalopathy
encephalopathy based may be discharged if there is a proper caregiver at home.
on grade?
Patients with grade III or IV must be admitted to the hospital and often
to the intensive care unit.
Lactulose is a synthetic disaccharide used to treat hepatic encephalopa-
thy.Rifaximin is a nonabsorbable antibiotic that can be administered
in addition to lactulose for patients who do not improve with lactulose
alone.
6. What are internal hem- Internal hemorrhoids are a normal anatomical part of the anal canal.
orrhoids made of? These hemorrhoids consist of connective tissue, smooth muscle fibers,
and terminal branches of the rectal arteries and veins providing normal
closure and pressures in the anal canal.
7. What do internal hem- They are located in the right anterior, right posterior, and left lateral
orrhoids arise from? areas of the canal and arise from the superior hemorrhoidal cushion.
8. What are external hem- External hemorrhoids are veins located below the dentate lineand are
orrhoids made of? superficial vessels covered with squamous epithelium.
9. Difference between vol- Image
untary and involuntary
, guarding on abdominal
exam?
10. Zollinger Ellison syn- - Gastrin-secreting tumor, causes peptic ulcer disease
drome rapid review - Found in duodenum, pancreas, often malignant
= Sx: abdominal pain, chronic diarrhea, weight loss
- PE: epigastric tenderness
- Endoscopy will demonstrate prominent gastric folds and solitary pep-
tic ulcers typically located in the duodenum.
- Labs: elevated serum gastrin level (> 1,000 pg/mL)
- Tx: H2 blockers, PPI, surgery
- Associated with MEN1
If results of the gastric acid pH and serum fasting gastrin levels are
equivocal or nondiagnostic, then a secretin stimulation test is used to
differentiate Zollinger-Ellison syndrome from other causes of chronically
elevated gastrin levels.
11. What does secretin do? Secretin stimulates gastrinomas to release gastrin, therefore, patients
with Zollinger-Ellison syndrome will have a marked rise in serum gastrin
levels after the administration of secretin
12. What is a gastric bypass During this procedure, a small gastric pouch is created that is connected
procedure? to a loop of jejunum. The rest of the gastric remnant is left in place and
the proximal duodenum is connected to the distal jejunum. This creates
a bypass of a large portion of the stomach, duodenum, and proximal
jejunum. The procedure reduces the size of the stomach while creating
a short biliopancreatic tract.
13. In a gastric bypass pro- gastric volume, calories
cedure :
The surgery also creates changes in gut hormones, such as incretin, that
The procedure works by are thought to contribute to overall weight loss.
